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Hold Harmless and Release of Liability

To make your life easier, print, initial and sign. You will NOT be able to train without this on file!!!!


Mojo Dojo

Of

Castle Rock


1810 Park Street

Castle Rock, Colorado

80109


MJDJ School: 720.709.7312


lseawolf@mojodojo.org


ACCIDENT WAIVER AND RELEASE FORM


This accident Waiver and Release of Liability Must Be Signed to participate in any event or class;


Please be advised of of the Mojo Dofo magic words:


“Hawaiian Martial Arts and Stickfighting is dangerous. Only you are responsible for you, so protect yourself at all times.

No suing no one, for no reason, for nothing, no how, no way”.


Accordingly, the course of instruction offered by Mojo Dojo of Castle Rocknconsists of a fair to extreme amount of physical exertion, and thus requires physical endurance, mental and emotional limits and carries with it the potential for loss of property, serious injury and possibly death.


Also, I understand that the course of instruction is sometimes conducted outdoors, exposing students to conditions of terrain, weather, as well as flora and fauna, and that risks associated with this type of training. These risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people, including, but not limited to, participants, volunteers, spectators, coaches, event officials, event monitors, and/or producers of the event, and due to lack of hydration. Also, it should be known that these risks are not only inherent to the participants, also to volunteers as well.


I, hereby assume all risks while participating in these events, seminars and classes and I further realize that liability may arise from negligence, or carelessness on the part of the persons or entities involved in these events, seminars and classes and release them from liability due to dangerous or defective equipment or property owned, maintained, and/or controlled by said group because of their possible liability: Initial:________


I, as a participant, deny any medical, physical, psychological conditions that would prohibit activities in the Mojo Dojo curriculum and I certify that I am physically fit, have sufficiently trained for any event/class/seminar and have not been advised otherwise by a qualified medical professional.


In consideration of my application and permission to participate in this as well as any future Mojo Dojo events/classes/seminars, I hereby take action for executors, my administrators, heirs, next of kin, successors, and myself assign as follows:


  1. I waive, release and discharge from any and all liability for my death, dismemberment, disability, damaged property, theft and/or actions of any kind, which may hereafter accrue to me from Mojo Dojo, their owners, directors, officers, employees, volunteers, representatives and agents, event holders, event sponsors, event directors, event volunteers, staff, contractors and clientele; Initial:_________

  2. Indemnify and HOLD HARMLESS the entities or persons mentioned in this waiver of any and all liabilities or claims made by other individuals or entities as a result of any of my actions during this event/class/seminar; Initial________


I hereby consent to medical treatment, which may be deemed advisable in the event of injury, accident, and/or illness during events/classess/seminars. Should such injury require immediate advanced medical car, i understand I am personally responsible for all costs and liability of such treatment. Initial:___________


I understand that at any event/class/seminar, that I may be photographed and I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event/class/seminar holders, producers, sponsors and/or organizers with no compensation to me.


I affirm that I will never use the training given by Mojo Dojo curriculum to plan, assist and/or participate in any criminal or terrorist activity, and that I am compliant with legal status, manipulated by all levels of government which hold jurisdiction over any locations which Mojo Dojo may use for training purposes. Initial:_________


I acknowledge that this Accident Waiver and release of Liability form will be used by the event/class/seminar holders, sponsors, Center and organizers in which I participate and that will govern my actions and responsibilities during and after said event/class/seminar. Initial:_________


This Accident Waiver and Release of Liability form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

Initial______


I certify that I have read the above document and I understand it’s content


Bt registering, I acknowledge that I have read and understood the entire document, including the Mojo Dojo magis words.


Signature:____________________________________Date:________________


Email:_________________________________________________


Printed Name:__________________________________________


Home Address:_________________________________________


Phone:_________________________________________________


Emergency Contact:_______________________________________


Additional Contact:_________________________________________


Preferred Medical Provider:_________________________________


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